Figure 5: Environmental noise exposure and subsequent mental stress cause a stress reaction through activation of either the hypothalamus-pituitary-adrenal (HPA) axis with subsequent cortisol release or by the activation of the sympathetic nervous system (SNS) with subsequent catecholamine formation. As a consequence, cerebral and vascular inflammatory and oxidative stress pathways as well as altered gene expression become active, leading to endothelial dysfunction. Taken together, these consequences contribute and interact with traditional risk factors, leading to neuronal, cerebrocardiovascular, and psychological disorders. Modified from Münzel et al. [100] and adapted from Daiber et al. [71] with permission.